Mechanism of action

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Impulsivity is a symptom of mania or hypomania!

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One very important reason to take the correct dose of the correct medication is shown below from the article: “Impulsivity and Risk Taking in Bipolar Disorder and Schizophrenia” published in Neuropsychpharmacology in September 2013. Here is the reference if anyone would like to read the whole article: http://www.nature.com/npp/journal/v39/n2/full/npp2013218a.html

Basically what this article is saying is that impulsiveness, which is defined as risky decision making, high risk attitudes, acting without planning, poor inhibition of risky actions, high risk attitudes, and rapid decision making (which basically means making decisions without thinking them through). Please understand that these are symptoms of mania. Once you are in a manic phase, you are going to do this. In a hypomanic phase, you are also going to do this but to a much lesser degree, your actions will not be as risky to your life or health. Please also understand that the only way to stop this from happening is to NOT go into a manic or hypomanic phase. The way to do that is to take the right amounts of the right medication as you doctor had prescribed. And if you feel like your mood is slipping towards mania or depression, to call your doctor and let them know. This is a BIOCHEMICAL disease involving levels or metabolism of neurotransmitters. All these neurotransmitters have certain effects on the brain. When their activity or levels of these neurotransmitters are high, we become impulsive. So, just take the right dose of your medication and head these problems off at the pass, nip them in the bud, stop them before they happen. If you don’t, this disease WILL ruin your life, it will destroy your peace of mind, it will destroy your relationships, it will destroy your friendships, it may even take your life. That is as bluntly as I can put it. I am definitely on the therapeutic dose of lithium and I’m staying on it for the rest of my life, I am not allowing this mood disorder to control my life or take days away from me or most importantly take my family or beloved friends away from me.

Not me, not now, not ever again! I hope you too will make a commitment to your health and sanity and your life, and follow your doctor’s advice to the letter.

Below in quotes are passages from the above mentioned article.

“Impulsiveness is a clinical feature of bipolar disorder. Broadly, impulsivity refers to a predisposition toward unplanned reactions without consideration of consequences and can include risky decision making, self-reported high-risk attitudes, poor response inhibition, and rapid decision making. 

Bipolar disorder is often characterized by impulsive behavior and increased tendency to work toward a reward, often without sufficient planning. Although risky-impulsive behavior is a diagnostic criterion for mania and bipolar patients consistently show abnormalities on self-report measures of impulsivity, they do not consistently show deficits on behavioral tasks that require planning and forethought. These differences may reflect the multi-faceted nature of impulsivity, or the measurement tools used to assess the construct.

Finally, some of the mixed findings in bipolar disorder and schizophrenia regarding impulsivity and risk taking may be attributable to the types of medications patients are taking. The neurochemical basis of impulsivity and risk taking involves dopaminergic, serotonergic, and other neurotransmitter systems, and these systems are affected by antipsychotic (AP) medications. Some studies find a reduction in impulsiveness associated with AP medications, whereas others find no such effect in psychotic samples. Thus, it is important to consider the role of AP medications on measures of impulsivity and risk taking.

This is one of the first studies to examine both self-report and behavioral measures of impulsivity in bipolar disorder and schizophrenia. The study had two goals. The primary goal was to conduct a careful analysis of impulsivity using multiple approaches across three groups: bipolar disorder patients, schizophrenia patients, and healthy controls. The secondary goal was to compare subgroups of bipolar disorder patients who differed in terms of AP medications and history of psychosis on measures of impulsivity and risk taking.”

 

 

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Lithium, the miracle drug for people with mood disorders!!!

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Lithium is a naturally occurring element. It is the same element that is used in batteries. But it is a Godsend for people with bipolar d/o. It stabilizes our moods. It stops the swings altogether or at least stops them from being too extreme. In areas where the concentration of lithium in drinking water is high, the incidence of mood disorders is lower!!! It is a calming mineral that helps with mania and, to a lesser degree, with depression. The general dose is 900 mg per day. I was on 300 mg because of the few side effects I had (fine muscle tremors, frequent urination, hair loss, acne, weight gain, GI problems.) But that was not enough to control my mood swings, so I went up to 600 mg/day, and that was better, but my swings were still not controlled. Now I am on 900 mg per day. Even though my right hand shakes a LOT, more of my hair is falling out, and I may get acne now and then, however to be stable mood wise is very, VERY important to me. So I am taking hair skin and nails vitamins, using benzoyl peroxide and living with fine muscle tremors. I am confident that the 900 mg dose of lithium is going to keep me in the normal phase, without swings that are too extreme in either the depressive or manic direction.

Lithium possesses unique anti-suicidal properties that set it apart from other agents. With respect to cognition, studies suggest that lithium may reduce cognitive decline in patients. It is seen to have a protective effect on people’s brains. The neuronal cell death that is seen in people with bipolar disorder is decreased when they are on Li+. As neurons die, venticles in the brain increase, this is also seen to lessen in patients who take Li+!!! It even has been hypothesized that Li+ causes neuronal cell growth, thereby reversing the damage that bipolar d/o inflicts upon its victims. So I am very happy, thrilled in fact, to know that the Li+ I take is not only preventing this disease from having an effect on me, but it is also protecting and regenerating my neurons. :)))))

The molecular mechanism of lithium (Li+) seems to be related to its similarity to sodium (Na++). It is taken up by neurons through the same pump that pumps in Na+ (Yes there are pumps that pump ions, such as calcium (Ca++) potassium (K+), in and pumps that pump ions out of all cells, including neurons. Pretty amazing hunh?) 

Evidence from both in vitro and in vivo studies has demonstrated that lithium exerts multiple effects on neurotransmitter/receptor-mediated signaling, ion transport, signal transduction cascades, hormonal and circadian regulation, and profoundly alters gene expression patterns.

Li+ reduces excitatory (dopamine and glutamate) but increases inhibitory (GABA) neurotransmission; however, these broad effects are underpinned by complex neurotransmitter systems that strive to achieve homeostasis by way of compensatory changes. For example, at an intracellular and molecular level, lithium targets second-messenger systems that further modulate neurotransmission. For instance, the effects of lithium on the adenyl cyclase and phospho-inositide pathways, as well as protein kinase C, may serve to dampen excessive excitatory neurotransmission. All this means is that Li+ affects molecules that are called second messengers (the neurotransmitter being the first messenger) and that normally transmit the signal, well Li+ stops the excitatory signals. Makes sense, as it a cracker jack mania buster!

Li+ also has inhibitory actions on inositol monophosphatase, inositol polyphosphate 1-phosphatase, glycogen synthase kinase-3, fructose 1,6-bisphosphatase, bisphosphate nucleotidase, and phosphoglucomutase enzymes. Some of these enzymes are involved in increasing activity of neurons in response to neurotransmitters, such as dopamine, serotonin, epinephrine, norepinephrine, and GABA. So again, Li+ stops excitatory signals from being passed from one neuron to another, thereby decreasing neuronal activity. This is good, because in mania your brain is working like gangbusters! And it needs to be slowed down. So Li+ does that. 

If your doctor has prescribed Lithium for you, please take it. It is a wonderful medication, which will save your neurons, your brain, your relationships, and maybe even your life.